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Falls: Risk, Prevention and Rehabilitation

A special issue of Applied Sciences (ISSN 2076-3417). This special issue belongs to the section "Applied Biosciences and Bioengineering".

Deadline for manuscript submissions: closed (30 November 2023) | Viewed by 18777

Special Issue Editor


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Guest Editor
Institute for Health and Sport (IHES), Victoria University, Melbourne, VIC 3011, Australia
Interests: minimisation of falls risks among older adults; understanding biomechanical factors for knee osteoarthritis; effects of 3D visual perception on flooring to control walking patterns to reduce slipping risks; biomechanical modelling and simulation of the major factors of falls when older adults are walking, (i.e. tripping, slipping and balance loss); footwear ergonomics to control gait patterns
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

In many countries advances in medical science and stronger social security systems are improving longevity. But the pursuit of longer, healthier, and more physically active lives, rather than simply prolonging life, is also critically important for both individuals and national security. Opportunities for people to lead healthier lives are, however, seriously compromised by falls-related injuries. In addition to high direct mortality, falls lead to secondary health problems, reduced quality of life, and considerable medical costs. Falls are, therefore, critically life-threatening for people. There is a worldwide research effort to combat this problem and our contribution will be a Special Issue for which we are inviting manuscript submissions in the following subdisciplines: (1) falls risk identification, (2) falls prevention strategies and (3) rehabilitation interventions for falls-related injuries. Empirical research articles and comprehensive reviews will be considered. Sound study designs and high scholarly standards are essential, but we will also consider contributions reporting findings from smaller samples when there are constraints on participant recruitment and testing. Studies reporting the findings from practical physical health interventions in real-world settings are also prioritised topics.

Dr. Hanatsu Nagano
Guest Editor

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Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2400 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • falls prevention
  • tripping
  • slipping
  • rehabilitation
  • walking
  • gait
  • falls risk
  • sensor

Published Papers (9 papers)

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Research

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13 pages, 2229 KiB  
Article
Effects of Acute Exposure to Virtually Generated Slip Hazards during Overground Walking
by Hunter Derby, Nathan O. Conner, Jacob M. Hull, Faith Hagan, Sally Barfield, Timothy Stewart, J. Adam Jones, Adam C. Knight and Harish Chander
Appl. Sci. 2023, 13(23), 12848; https://doi.org/10.3390/app132312848 - 30 Nov 2023
Viewed by 624
Abstract
Postural instability and the inability to regain balance during slip-induced events are the leading causes of falls on the same level in occupational environments. Virtual reality (VR) provides the potential to be immersed in a realistic environment, exposing themselves to fall-risk hazards without [...] Read more.
Postural instability and the inability to regain balance during slip-induced events are the leading causes of falls on the same level in occupational environments. Virtual reality (VR) provides the potential to be immersed in a realistic environment, exposing themselves to fall-risk hazards without the risk of injury real-world exposure may cause. Therefore, the purpose of this study was to compare the lower extremity joint kinematics of the slipping leg during real and virtually generated slip hazards. A secondary purpose was to investigate dynamic postural stability following acute exposure to real (REAL) and virtual (VR) environmental conditions. A total of 14 healthy participants’ (7 men, 7 women; age: 23.46 ± 3.31 years; height: 173.85 ± 8.48 cm; mass: 82.19 ± 11.41 kg; shoe size (men’s): 9.03 ± 2.71) knee and ankle joint kinematics were compared during exposure to both REAL and VR environments. Participants then completed a series of Timed Up-and-Go (TUG) variations (standard, cognitive, manual) at the beginning and the end of exposure to each environment. TUG-C involved backwards counting and TUG-M involved walking with an anterior load. Environmental exposure was selected in a counterbalanced order to prevent an order effect. Knee and ankle joint kinematics were analyzed separately using a 2 × 3 repeated measure ANOVA to compare environments as well as gait types at an alpha level of 0.05. TUG variations were also analyzed separately using a 3 × 3 repeated-measures ANOVA to compare TUG variations and environment. No significant differences were observed for knee or ankle joint kinematics between environments or gait types. There were also no significant interactions between environments and gait types. However, significant differences were observed for TUG-C following VR environmental conditions (p = 0.027). Post hoc comparisons revealed significantly lower times for TUG-C following VR exposure (p = 0.029). No significance was observed for TUG-S or TUG-M. Current findings suggest the potential effectiveness of VR as a means of fall prevention training for occupational populations based on improved TUG-C and similar lower extremity joint kinematics in REAL and VR conditions. Full article
(This article belongs to the Special Issue Falls: Risk, Prevention and Rehabilitation)
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21 pages, 2041 KiB  
Article
A Managerial Approach to Investigate Fall Risk in a Rehabilitation Hospital
by Giuseppe Cesarelli, Rita Petrelli, Sarah Adamo, Orjela Monce, Carlo Ricciardi, Emanuele Cristallo, Maria Ruccia and Mario Cesarelli
Appl. Sci. 2023, 13(13), 7847; https://doi.org/10.3390/app13137847 - 4 Jul 2023
Viewed by 1183
Abstract
Among the issues on which health directions focus, fall risk is one of major importance since it affects patients hospitalized in both acute and rehabilitative hospitals. In this context, few publications have proposed a managerial approach aimed at (a) investigating several factors related [...] Read more.
Among the issues on which health directions focus, fall risk is one of major importance since it affects patients hospitalized in both acute and rehabilitative hospitals. In this context, few publications have proposed a managerial approach aimed at (a) investigating several factors related to falls and (b) trying to acquire more knowledge and comprehension when analyzing the data collected. Consequently, this paper pursues such objectives by investigating data related to falls (and the recurrence of falls) registered in a rehabilitation hospital within the years 2020 and 2021. A multidisciplinary team (clinical staff and engineers) registered 238 first falls, and descriptive statistics were used to analyze the fall-related anamnestic and clinical data. Then, appropriate statistical analyses were used to compare the same data—this time distinguishing fallers/recurrent fallers—and, again, descriptive statistics were used to analyze the consequences of falls. The statistical analyses allowed us to gain insights into the fall mechanisms, the main places in which falls took place, the impacts of drugs, and fall consequences (e.g., the potential extra costs for the hospital). Moreover, the Morse and Stratify risk tools, state of consciousness, and fall containment measures were proven to be statistically significant features for distinguishing fallers and recurrent fallers, and they may be further investigated to define more accurate preventive measures within rehabilitation hospitals. Full article
(This article belongs to the Special Issue Falls: Risk, Prevention and Rehabilitation)
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12 pages, 852 KiB  
Article
Receiver Operating Characteristic Analysis of Posture and Gait Parameters to Prevent Frailty Condition and Fall Risk in the Elderly
by Valentina Presta, Laura Galuppo, Giancarlo Condello, Francesca Rodà, Prisco Mirandola, Marco Vitale, Mauro Vaccarezza and Giuliana Gobbi
Appl. Sci. 2023, 13(6), 3387; https://doi.org/10.3390/app13063387 - 7 Mar 2023
Cited by 2 | Viewed by 1495
Abstract
Prevention strategies should be constantly improved to manage falls and frailty in the elderly. Therefore, we aimed at creating a screening and predictive protocol as a replicable model in clinical settings. Bioimpedance analysis was conducted on fifty subjects (mean age 76.9 ± 3.69 [...] Read more.
Prevention strategies should be constantly improved to manage falls and frailty in the elderly. Therefore, we aimed at creating a screening and predictive protocol as a replicable model in clinical settings. Bioimpedance analysis was conducted on fifty subjects (mean age 76.9 ± 3.69 years) to obtain body composition; then, posture was analysed with a stabilometric platform. Gait performance was recorded by a 10 m walking test, six-minute walking test, and timed up and go test. After 12 months, subjects were interviewed to check for fall events. Non-parametric analysis was used for comparisons between fallers and non-fallers and between able and frail subjects. ROC curves were obtained to identify the predictive value of falling risk and frailty. Path length (area under the curve, AUC = 0.678), sway area (AUC = 0.727), and sway speed (AUC = 0.778) resulted predictive factors of fall events (p < 0.05). The six-minute walking test predicted frailty condition (AUC = 0.840). Timed up and go test was predictive of both frailty (AUC = 0.702) and fall events (AUC = 0.681). Stabilometry and gait tests should be, therefore, included in a screening protocol for the elderly to prevent fall events and recognize the condition of frailty at an early stage. Full article
(This article belongs to the Special Issue Falls: Risk, Prevention and Rehabilitation)
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15 pages, 3531 KiB  
Article
Obstacle Crossing in Older Adults with Total Knee Arthroplasty at the Initial Swing Phase
by Archrawadee Srijaroon, Pongsak Yuktanandana and Sompol Sanguanrungsirikul
Appl. Sci. 2022, 12(20), 10198; https://doi.org/10.3390/app122010198 - 11 Oct 2022
Cited by 1 | Viewed by 1337
Abstract
After undergoing a total knee arthroplasty (TKA) procedure, patients are at a high risk of falling because they present with ineffective mobility within a complex environment, especially during obstacle crossing. Toe clearance (TC) is an important factor to quantify the risks of trip-related [...] Read more.
After undergoing a total knee arthroplasty (TKA) procedure, patients are at a high risk of falling because they present with ineffective mobility within a complex environment, especially during obstacle crossing. Toe clearance (TC) is an important factor to quantify the risks of trip-related falls. The study aimed to investigate TC height and toe trajectory and joint kinematic changes occurring in the lower limb following TKA during obstacle crossing at the initial swing phase. Twenty TKA patients, including those in preoperative and postoperative stages (three and six months), performed obstacle-crossing tasks to compare their performance with 20 healthy controls. Participants walked at self-pace along an 8 m walkway with 2.5, 5, and 10 cm obstacles positioned along the center of the path. For each participant, body segment motions were traced using reflective markers and the kinematics of lower extremity, toe clearance, and gait parameters were analyzed using a 3D-motion analysis system. TKA patients had lower TC height and toe trajectory at six months, slower toe elevation than controls when swing toe crossed 5 and 10 cm obstacles (p < 0.05), and decreased hip and knee flexion (p < 0.05). These altered gait patterns with decreased TC height and toe trajectory were identified as tripping factors as the toe trajectory was close to the ground surface. TKA patients had acquired different lower limb kinematics to maintain adequate TC. At long-term follow-up, there was an increasing trend for patients to trip after surgery. Therefore, more focus is needed on the exercise prescription for rehabilitation programs to improve muscle strength and stepping control. Full article
(This article belongs to the Special Issue Falls: Risk, Prevention and Rehabilitation)
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12 pages, 952 KiB  
Article
Feasibility of Pilates for Late-Stage Frail Older Adults to Minimize Falls and Enhance Cognitive Functions
by Eri Sarashina, Katsuyoshi Mizukami, Yasuyo Yoshizawa, Junko Sakurai, Akane Tsuji and Rezaul Begg
Appl. Sci. 2022, 12(13), 6716; https://doi.org/10.3390/app12136716 - 2 Jul 2022
Cited by 1 | Viewed by 1999
Abstract
Globally, we are facing the tendency of aging, and demands for health enhancement among the older population have been steadily increasing. Among various exercise interventions, Pilates has been popularly utilized in rehabilitation; therefore, it is considered suitable for vulnerable populations. In this study, [...] Read more.
Globally, we are facing the tendency of aging, and demands for health enhancement among the older population have been steadily increasing. Among various exercise interventions, Pilates has been popularly utilized in rehabilitation; therefore, it is considered suitable for vulnerable populations. In this study, frail late-stage older adults (>75 years) participated in a modified Pilates program (30 min per session, once a week for eight weeks). Age- and condition-matched Controls were also involved as the benchmark to reveal the effect of Pilates. While only the Pilates group participated in the exercise intervention, both groups undertook the health assessments twice (before and after the intervention period). Assessments included: (i) falling risk based on 3D motion capture systems and (ii) overall cognitive functions utilizing Mini-Mental State Examination and executive function with the use of Trail Making Test-A (TMT-A). Two-dimensional mood state was also used to measure changes in mood due to Pilates intervention. An 8-week Pilates intervention was effective in achieving higher and symmetrical swing foot control. Dynamic balance at heel contact was also improved by extending the spatial margin in case of slipping. Despite the trend of positive Pilates effects on executive functions (29% improvement) confirmed by TMT-A, no significant effects were observed for cognitive functions. Positive mood changes were achieved by Pilates intervention, which may be the key for late-stage seniors to continue their participation in exercise programs. While further studies with a larger sample size are essential, Pilates appears to provide adequate exercise for the frail late-stage older population to minimize frailty. Full article
(This article belongs to the Special Issue Falls: Risk, Prevention and Rehabilitation)
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20 pages, 348 KiB  
Article
Using Machine Learning to Identify Feelings of Energy and Fatigue in Single-Task Walking Gait: An Exploratory Study
by Ahmed M. Kadry, Ahmed Torad, Moustafa Ali Elwan, Rumit Singh Kakar, Dylan Bradley, Shafique Chaudhry and Ali Boolani
Appl. Sci. 2022, 12(6), 3083; https://doi.org/10.3390/app12063083 - 17 Mar 2022
Cited by 8 | Viewed by 2139
Abstract
The objective of this study was to use machine learning to identify feelings of energy and fatigue using single-task walking gait. Participants (n = 126) were recruited from a university community and completed a single protocol where current feelings of energy and [...] Read more.
The objective of this study was to use machine learning to identify feelings of energy and fatigue using single-task walking gait. Participants (n = 126) were recruited from a university community and completed a single protocol where current feelings of energy and fatigue were measured using the Profile of Moods Survey–Short Form approximately 2 min prior to participants completing a two-minute walk around a 6 m track wearing APDM mobility monitors. Gait parameters for upper and lower extremity, neck, lumbar and trunk movement were collected. Gradient boosting classifiers were the most accurate classifiers for both feelings of energy (74.3%) and fatigue (74.2%) and Random Forest Regressors were the most accurate regressors for both energy (0.005) and fatigue (0.007). ANCOVA analyses of gait parameters comparing individuals who were high or low energy or fatigue suggest that individuals who are low energy have significantly greater errors in walking gait compared to those who are high energy. Individuals who are high fatigue have more symmetrical gait patterns and have trouble turning when compared to their low fatigue counterparts. Furthermore, these findings support the need to assess energy and fatigue as two distinct unipolar moods as the signals used by the algorithms were unique to each mood. Full article
(This article belongs to the Special Issue Falls: Risk, Prevention and Rehabilitation)
17 pages, 1576 KiB  
Article
Older Adults’ Experience of an Exergaming Intervention to Improve Balance and Prevent Falls: A Nested Explanatory Qualitative Study
by Christine Rogers, Delva Shamley and Seyi Amosun
Appl. Sci. 2021, 11(24), 11678; https://doi.org/10.3390/app112411678 - 9 Dec 2021
Cited by 2 | Viewed by 2832
Abstract
Falls are frequent and life-changing events for older adults worldwide. The ageing phenomenon has arrived in developing countries, which experience tensions between curative and rehabilitative services, combined with an increase in non-communicable diseases. Policies addressing issues of ageing have been poorly implemented, and [...] Read more.
Falls are frequent and life-changing events for older adults worldwide. The ageing phenomenon has arrived in developing countries, which experience tensions between curative and rehabilitative services, combined with an increase in non-communicable diseases. Policies addressing issues of ageing have been poorly implemented, and there are few fall prevention initiatives. Compelling evidence from the Global North supports exercise-based interventions to improve balance and reduce fall risk in older adults. More recently, attention has focused on interactive videogaming, known as exergames, as a novel way to manage fall risk with exercise. Commercially available exergames have inherent appeal for low- and middle-income country contexts, where rehabilitation professionals and resources are scanty. The aim of this study was to explore the feasibility of a large-scale randomized control trial comparing an exergaming intervention with the gold-standard Otago Exercise Programme and a no-intervention arm. Exercise adherence was poor in both intervention arms, and this prompted a shift to mixed methodology to explore the construct of falls and participants’ experience of the exergaming intervention. Focus groups were conducted, and the results were analysed using content analysis. Whereas the results demonstrated improvements in physical outcome measures (e.g., Timed-Up-and-Go, MiniBESTest) related to balance and falls that were encouraging in both the gold-standard and exergaming intervention groups, few participants achieved optimal adherence. Attitudes toward falls and fall prevention were explored, as well as participants’ experiences of the exergaming programme. Consistent with a developing country context, participants acknowledged both intrinsic and extrinsic fall risk factors. Exergaming participants enjoyed the fun and playful aspects of the exercise programme, yet these were not sufficient to maximize adherence. The focus groups described the barriers and facilitators to participation, which included motivation. The focus groups discussed strategies to enhance participation, and these are discussed in the context of exergaming. Full article
(This article belongs to the Special Issue Falls: Risk, Prevention and Rehabilitation)
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Review

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14 pages, 1794 KiB  
Review
Gait Biomechanics for Fall Prevention among Older Adults
by Hanatsu Nagano
Appl. Sci. 2022, 12(13), 6660; https://doi.org/10.3390/app12136660 - 30 Jun 2022
Cited by 6 | Viewed by 3556
Abstract
In our currently ageing society, fall prevention is important for better healthy life expectancy and sustainable healthcare systems. While active outdoor walking is recommended as adequate exercise for the senior population, falls due to tripping and slipping exist as the primary causes of [...] Read more.
In our currently ageing society, fall prevention is important for better healthy life expectancy and sustainable healthcare systems. While active outdoor walking is recommended as adequate exercise for the senior population, falls due to tripping and slipping exist as the primary causes of severe injuries. Minimum foot clearance (MFC) is the lowest vertical height of the foot during the mid-swing phase and indicates the risk of tripping. In contrast, coefficient of friction (COF) factors determine the occurrence of falls from slipping. Optimisation of the MFC and the COF for every step cycle prevents tripping and slipping, respectively. Even after the initiation of hazardous balance loss (i.e., tripping and slipping), falls can still be prevented as long as the requirements for balance are restored. Biomechanically, dynamic balance is defined by the bodily centre of mass and by the base of support: spatially—margin of stability and temporally—available response time. Fall prevention strategies should, therefore, target controlling the MFC, the COF and dynamic balance. Practical intervention strategies include footwear modification (i.e., shoe-insole geometry and slip-resistant outsoles), exercise (i.e., ankle dorsiflexors and core stabilisers) and technological rehabilitation (i.e., electrical stimulators and active exoskeletons). Biomechanical concepts can be practically applied to various everyday settings for fall prevention among the older population. Full article
(This article belongs to the Special Issue Falls: Risk, Prevention and Rehabilitation)
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Other

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9 pages, 572 KiB  
Brief Report
Effects of an Adapted Sports Intervention on Elderly Women in Need of Long-Term Care: A Pilot Study
by Takashi Kawano, Goro Moriki, Shinya Bono, Junya Masumoto, Nobuyuki Kaji, Hungu Jung and Masahiro Yamasaki
Appl. Sci. 2022, 12(6), 3097; https://doi.org/10.3390/app12063097 - 18 Mar 2022
Cited by 2 | Viewed by 2151
Abstract
This study aimed to evaluate the effects of an adapted sports intervention on elderly women in need of long-term care (NLTC). Although participation in sports activities positively impacts subjective health status, few studies have evaluated the safety, comfort, and effectiveness of competitive sports [...] Read more.
This study aimed to evaluate the effects of an adapted sports intervention on elderly women in need of long-term care (NLTC). Although participation in sports activities positively impacts subjective health status, few studies have evaluated the safety, comfort, and effectiveness of competitive sports in elderly women in NLTC. In this study, ten elderly women in NLTC (age: 80.6 ± 8.2 years) were asked to participate in boccia, a sport adapted to prevent falls. Participants completed the Profile of Mood States 2nd Edition Short-Form and the Medical Outcome Study 36-Item Short-Form Health Survey Version 2. The results showed an improvement in mood states (anger–hostility, tension–anxiety, and total mood disturbance) of elderly women in the NLTC group compared with the control group. Therefore, boccia, an adapted sport, can be considered a safe and competitive option for such women. Full article
(This article belongs to the Special Issue Falls: Risk, Prevention and Rehabilitation)
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